Between 1988 and 2007, the federal government created a number of arm’s-length agencies to address various health policy issues – among them, developing a mental-health strategy, collecting national data, reviewing the effectiveness of drugs and devices.
But a new report says the eight agencies, known collectively as the pan-Canadian health organizations (PCHOs), need a fundamental revamp to eliminate duplication and address yawning policy gaps.
“The role of this suite of agencies should be to accelerate a vision of what health care should look like in the 21st century,” said Danielle Martin, vice-president of medical affairs and health systems solutions at Toronto’s Women’s College Hospital and co-chair of the PCHO External Review.
Co-chair Pierre-Gerlier Forest, director of the school of public policy at the University of Calgary, said a housecleaning is needed because “many things aren’t working” – to the point it is unclear if the agencies are having any appreciable impact on the health-care system.
The eight PCHOs (and their 2017-18 budgets) are:
- Canadian Centre on Substance Use and Addiction (CCSA), $8.83-million;
- Canadian Agency for Drugs and Technologies in Health (CADTH), $31.1-million;
- Canadian Institute for Health Information (CIHI), $109.3-million;
- Canadian Foundation for Healthcare Improvement (CFHI), $19.1-million;
- Canada Health Infoway (Infoway), $116.8-million;
- Canadian Patient Safety Institute (CPSI), $8.6-million;
- Canadian Partnership Against Cancer (CPAC), $39.9-million;
- Mental Health Commission of Canada (MHCC), $19.54-million.
The external review was commissioned by federal Health Minister Ginette Petitpas Taylor in October, 2017.
On Tuesday, the panel offered the minister four scenarios for change, each with a signature agency and philosophical bent and requiring significant recasting or elimination of existing organizations:
1. Efficiency: The creation of an agency to be called Health Quality Canada to promote system-wide improvement in the delivery of health services; it would integrate CPSI, CPAC and CFHI. CIHI, CADTH and Infoway would maintain similar functions. This is essentially the status quo, with some minor changes.
2. Innovation: Create the Health Innovation Agency of Canada to support the scaling up and adoption of existing innovations; it would absorb CFHI and CPSI. Also create Connected Data Canada to expand on data collection and use; it would be merger of Infoway and CIHI. CADTH would maintain a similar function. (This scenario is similar to one proposed in the 2015 Naylor report on innovation.)
3. Engagement: Create the Canadian Networks of Health, which would absorb the functions of many of the agencies – but centralized, instead of in rigid, Ottawa-based organizations. This scenario would also include Connected Data Canada and a Canadian Drug Agency, a bolstered version of CADTH.
4. Equity: Create a Canadian Council for Health Equity, which would focus on modernizing the medicare basket of services (notably by including psychological services) and help provinces and territories determine what is covered by public insurance plans. This, too, would include Connected Data Canada and a Canadian Drug Agency.
All the scenarios underscore that big data, digital health and prescription drugs (and likely pharmacare) will play an ever-growing role in health care.
It is also clear that, in all the scenarios, three organizations come out big losers: the Mental Health Commission of Canada, the Canadian Partnership Against Cancer and the Canadian Centre on Substance Abuse and Addiction.
Dr. Martin said it is not because issues such as cancer, mental health and addiction are unimportant – on the contrary, these problems are so pervasive they need to be tackled on a broader scale, not merely by small, stand-alone organizations.
In addition to the four scenarios, the review made a number of overarching recommendations. For example, it said all the PCHOs should play a role in reconciliation by paying more attention to Indigenous health-care issues, which they have neglected. Similarly, there should be more federal-provincial-territorial collaboration and networking and less centralization in Ottawa.
Ottawa currently spends more than $350-million annually funding the eight PCHOs. The review committee did not have a mandate to cost out its recommendations, but there is no doubt that all the scenarios, except the status quo, would require significantly more money. For example, the Naylor commission estimated that making federal health agencies more innovative and effective would cost an additional $1-billion annually.
Dr. Martin said there is no ideal scenario; rather, the choice would depend on the federal government’s philosophy and the role it intends to play in health care.
“It’s clear the federal government is back and wants to be more active in health care,” she said. “If we want 21st-century care, we need to invest in 21st-century health organizations.”
André Picard